The principles on which the U.S. was founded were anti-tyranny,
freedom, and autonomy. As a result, the founding fathers
constructed our country with checks and balances built into
government processes and limited government intrusion on the lives
of its citizens. Therefore, one can argue that a universal health care
system run by the government that mandates coverage for all
citizens goes against the very principles that built this country. I truly
believe that this has been the foundation for much of the resistance
to a government-run single-payer health care system in the US. In
many ways, this resistance has been slowly eroding over time, and
our health care system has evolved from something that looked like a
free-market system to today’s patchwork system that is more closely
resembling a single-payer structure.
There have been and continue to be many obstacles to universal
health care in this country based on a foundation that many
Americans feel that health care is not a responsibility of our
government (Rashford, 2007). In fact, most physicians polled support
national health insurance but oppose the government as the single
payer (Rashford, 2007). One of the reasons our physicians, nurses,
and medical staff have some of the highest incomes in the world is
based on private insurance money that flows into the health care
system, not Medicare and Medicaid (McDonough, 2017). Countries
with single-payer health care systems pay medical staff at much
lower rates and provide fewer specialized services than the U.S.
(Rashford, 2007). Therefore, it is not difficult to understand why the
American Medical Association lobbies so hard against a government-
run system. Our government is not a unified centralized one, like you
find in the UK and Sweden; our government has multiple legislative
chambers, courts, lobbyists, and state governments that can enact or
block legislation (Greer et al., 2019). As a result, our system is
designed for opponents of a policy to wield enormous impacts. The
U.S. has a history of rejecting government-established spending
limits, which would be required under a universal health care
structure; this drives the opposition from insurance companies,
health care providers, and other businesses in the medical industry
(Rashford, 2007). Finally, there has been a lack of agreement on the
structure of funding sources for a single-payer system (Rashford,
2007).
The obstacles mentioned have led to the failures by three states to
implement a single-payer system within their borders: California in
1994, Oregon in 2002, and Colorado in 2016 (McDonough, 2017). In
these states, voters could not be convinced that the proposed
systems would be financially sound. In addition, tax rate sticker
shock destroyed an attempt by Vermont in 2014 to pursue a single-
payer system when income taxes were projected to rise to 9.5% and
payroll taxes to 11.5% to finance the system (McDonough, 2017). I
believe that universal health care in this country is inevitable;
however, who will finance the system is still open for debate. Many
obstacles remain to be overcome.
Greer, S. L., Jarman, H., & Donnelly, P. D. (2019). Lessons for the
United States from single-payer systems. American journal of public
health, 109(11), 1493-1496.
McDonough, J. E. (2017). Questions for New Single-Payer
Advocates. The Milbank Quarterly, 95(4), 702.
Rashford, M. (2007). A universal healthcare system: is it right for the
United States?. In Nursing Forum (Vol. 42, No. 1, pp. 3-11). Malden,
USA: Blackwell Publishing Inc.
